How The Hell Did We Get Here? 4

This review, “Comparing Australian with Canadian and New Zealand Primary Care Health Systems in Relation to Indigenous Populations: Literature Review and Analysis” provides a good overview of the differences and similarities between the approaches to Indigenous health in Australia, NZ and Canada. As far as similarities go there are many; a significant differential in heath status is the norm and funding shortfalls for health service provision relative to need are widely reported.

Yet, the life expectancy differential in Australia (17 yrs) is twice that of NZ and Canada. So it doesn’t appear that it is just under-spending on health that is the issue.

The review notes several relevant findings on this point,

A key cause of Indigenous Australians’ poor health status compared with Indigenous populations in Canada and New Zealand may be cultural—namely, the rejection of the colonists’ health system, with an increasing rather than declining lack of trust in it.

And,

Emotional and cultural barriers are two of five main risk factors identified for Indigenous ill-health in Australia, resulting in high rates of mental health problems and an inability or unwillingness to access primary health care services.

A highly significant difference between Australia and the other is the issue
of formal recognition of ‘First Peoples’,

Treaties have contributed to the improved health status of Indigenous populations in Canada and New Zealand, according to Ring and Firman (1998): “Treaties, no matter how loosely worded, have appeared to play a significant and useful role in the development of health services, and in social and economic issues”. In Australia, the lack of distinctive legal recognition of Indigenous people’s autonomy and culture may compound the effects of being a small demographic minority in a large continent in contributing to the poor health, welfare and more general socio-economic outcomes of Indigenous Australians.

So, how do such esoteric matters contribute to poor health outcomes?

A leading epidemiologist, Michael Marmot, has been researching this exact question. Traditional risk factors for poor health, such as high blood pressure, lack of exercise etc., can only account for part of the disease burden that is observed in any given population, even when income and education levels are considered. This unexplained portion, Marmot has attributed to “control factors”, that is, the degree of autonomy and freedom from external controls, that we experience in our lives. The higher one’s position in the social realm, the greater control one has. While the mechanism of action is unknown, he argues that it may be a two part action. One that relates to the worth we are given in society that either boosts or undermines our own sense of worth, and hence our level of motivation to make healthy lifestyle choices. The second may be that having lower levels of control is more stressful and certain stress hormones may have a negative impact on immune functioning, predisposing to illness.

Perhaps one of the most powerful acts of ‘practical reconciliation’ might be one that the proponents of this practical approach would deride as ‘merely symbolic’- a treaty with Aboriginal Australians recognising their ‘First Peoples’ status.

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